Survival of Children with HIV in Asia

March 2011—TREAT Asia initiated a study in 2008 to assess the outcomes of children with HIV in Asia. The TREAT Asia Pediatric HIV Observational Database (TApHOD) now includes data from more than 3,700 children from Cambodia, India, Indonesia, Malaysia, Thailand, and Viet Nam. An analysis examining survival rates and factors associated with early death was conducted in this regional cohort.1

A total of 2,280 children were included in this analysis of data collected to March 2009. Of the 1,752 children who had ever received antiretroviral therapy (ART), the median age at the start of ART was 6.5 years. After a median of 3.1 years of follow-up, 6.6 percent had died, 8.8 percent were lost to follow-up, and 6.8 percent had been transferred to other clinical facilities. The risk of death dropped from 10.2 per 100 child-years in the first three months of ART to 0.9 per 100 child-years after 12 months. Risk of death was highest in those with the lowest CD4 levels, low weight by standardized growth curves, and severe clinical disease.

The 528 children who never received ART were followed for a median of 0.9 years; 6.8 percent died, 46 percent were lost to follow-up, and 6 percent were transferred to another clinical facility. Overall, the most common causes of death were pneumonia (lung infection) and sepsis (i.e., severe infections in the blood and other body tissues).

These results demonstrate the higher risk of death when ART is started too late. Children with initial CD4 levels of less than five percent made up 28 percent of those who received ART and 39 percent of all deaths after ART. In comparison, children with initial CD4 levels of more than 15 percent made up 20 percent of the group receiving ART and only 7 percent of all deaths after ART. The high loss to follow-up among those who did not receive ART may have masked additional deaths in this group. Despite these concerns, the study also demonstrates that strong pediatric ART program retention is possible in resource-limited countries in Asia. Earlier diagnosis and ongoing support for pediatric care and treatment programs will help to ensure that children with HIV have the chance to live to adulthood.